Provider Demographics
NPI:1285962464
Name:WILLOW PERSONAL CARE ASSISTANTS, LLC
Entity type:Organization
Organization Name:WILLOW PERSONAL CARE ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CNA
Authorized Official - Phone:907-495-6778
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-0624
Mailing Address - Country:US
Mailing Address - Phone:907-495-6778
Mailing Address - Fax:907-495-6779
Practice Address - Street 1:MILE 69. 1 PARKS HIGHWAY
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688
Practice Address - Country:US
Practice Address - Phone:907-495-6778
Practice Address - Fax:907-495-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care